Player Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Ethnicity

White British

Black British

White Other

Black other

Asian

Chinese

Mixed race

Prefer not to say

Does the player have any medical conditions/allergies? *

Yes

No

Media Consent *

This is to certify that I have no objections to Worksop Town Academy or associated company using any photographic or video images of my child whilst attending a Worksop Town Academy event. Any images will only be used to promote the work of Worksop Town Adacemy/FC to partners and funders along with local, national and social media outlets.

I agree

I do not agree

Parent/Guardian Consent *

We are committed through trained and competent staff to providing a safe learning environment, however football is a contact sport and injuries may occur through no negligence of our staff. We feel it is our responsibility to ensure the safety of the attendee by making sure they come well equipped for the activity i.e. correct footwear, appropriate clothing, food/drinks if appropriate, medication (if applicable). I have read and understood this form, completed all the details requested to the best of my knowledge and will comply with the information set out. I acknowledge and accept that Worksop Town Academy or respective servants shall not have any liability in respect with any loss or damage to property and give permission for my child to receive emergency medical treatment in my absence if deemed necessary.

I agree

I do not Agree

Are you happy to subscribe to our emails/texts? *

This is so we can send you important information regarding the trials and the Academy thereafter. We will never pass on your information.

Fine by me!